With the advent of antiretroviral treatment (ART), many HIV-infected children are reaching adolescence and young adulthood. However, the impact of perinatal HIV infection on the critical developmental transition from adolescence to young adulthood is unknown. The proposed study is a competing continuation of our current NIMH funded R01 grant Mental Health and Risk Behavior in HIV+ Youths and Seroreverters (R01MH069133; PI:Mellins), informally known as CASAH-1 (Child & Adolescent Self-Awareness and Health). In CASAH-1, we are in the final year of collecting data from perinatally HIV-infected and perinatally HIV-exposed, but uninfected (seroreverter) youth, as well as their caregivers at baseline (youth ages 9-16 years) and 18-month follow-up (youth ages 11-18 years). Participants were originally recruited from four urban medical centers in NYC. In the proposed project, CASAH-2, we will study the impact of HIV infection on risk and adaptive behaviors as our sample of vulnerable youth approach and transition into young adulthood. We will examine how HIV infection and critical risk and protective factors from our theoretical model of health behavior, Social Action Theory, affect behavioral outcomes that may disrupt or enhance adult functioning. In CASAH-2, youths and caregivers will be re-recruited 1-3 years after their CASAH-1 follow-up interview. They will be interviewed at three additional follow-up time points in CASAH-2, each one year apart for a total of five interviews across CASAH-1 and CASAH-2. The interview assesses Behavioral Health Outcomes (including emotional and behavioral functioning, sexual and drug use behavior, and for infected youth, health care outcomes) as well as risk and protective factors that influence the Behavioral Health Outcomes. In CASAH-2, we will include variables that are particularly relevant for the transition to older adolescence and young adulthood, (e.g. functional milestones related to school/vocation, social relationships, pro-social conduct, and autonomy, and for the HIV+ youth, transition to adult HIV medical care). Few behavioral studies of perinatal HIV infection have focused on psychosocial variables nor have they followed youth into this older age range, and few have adequate comparison groups to identify correlates of risk and adaptive behavior unique to perinatally-infected youth across different developmental stages of adolescents and young adulthood. Such research will have important intervention implications for the US, and also for the much larger pediatric HIV epidemic in low- resource countries where, until recently, limited access to ART has resulted in millions of perinatally infected children. PUBLIC HEALTH RELEVANCE: Perinatally-infected youths are only now beginning to enter older adolescence and young adulthood in relatively large numbers in countries with longstanding access to antiretroviral treatment. Few studies exist on the developmental challenges posed by HIV and the factors that impede or promote the optimum development of these youths as they approach young adulthood. The proposed study would be one of the first of its kind to examine the impact of the HIV epidemic over time on the youths' ability to adapt and contribute to their communities as adults or conversely to pose a public health challenge as the result of high risk behavior. Findings will allow us to lay the groundwork for effective educational, therapeutic, and preventive interventions for a population fast emerging as a new risk group for poor health and behavioral outcomes in the United States (US). Furthermore, the unabated maternal HIV epidemic in Africa, Latin America, and Asia, where the numbers of HIV-infected and HIV-affected children are staggering, urgently warrants studies that can inform interventions in countries with limited resources.